Rehabilitation Protocol Following Flexor Tendon Repair Surgery Using the CoNextions TR® Tendon Repair System

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Flexor Tendon Repair Protocol Example

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After undergoing a procedure with the CoNextions TR® Tendon Repair System, a patient will begin their rehabilitation process. The patient will be guided by their surgeon to begin regaining their Range of Motion (ROM) of the repaired area(s). The patient should follow the advice of their surgeon or designated medical professional to get the best outcomes in healing after surgery. Rehabilitation often differentiates between each case and the surgeon’s preferences. This protocol is designed to give an example of the rehabilitation process for the CoNextions TR® Tendon Repair System.

Protocol

Dr. Gregory Kolovich, MD, at Optim Orthopedics in Georgia, provided his standard rehabilitation protocol for flexor tendon repairs after using the CoNextions TR Tendon Repair System (as of May 2024).

3-5 Days

Wound care/edema control and patient education.

Orthosis: Fabricate a custom dorsal blocking wrist, hand, and finger orthosis (WHFO) with the wrist in 15/20 degrees of extension, MP (metacarpophalangeal) flexion between 40-60 degrees and IP (interphalangeal) joints in a neutral position.

Exercises: (Out of the orthosis).

  1. Full passive finger flexion. Place and hold finger flexion.
    Then full active finger extension.
  2. Position the wrist in slight extension and begin active range of motion (AROM) focusing on gentle composite finger flexion up to half fist followed by full finger extension. Educate the patient to initiate movement with fingertips to promote tendon excursion.
  3. Wrist tenodesis exercises.

Week 2-4

Scar management with patient education.

Orthosis:
Continue with dorsal blocking WHFO or transition to custom tenodesis style orthosis, per MD approval, with the MPs in 40-60 degrees flexion, IPs in neutral and the wrist blocked at maximum 45 degrees of extension.

Exercises:

  1. Continue with initial exercises.
  2. Advance active composite finger flexion from half fist to full fist over the following weeks.

Week 5

Orthosis: Continue with orthosis management.

Exercises: (Out of the orthosis).

  1. Distal Interphalangeal (DIP) and Proximal Interphalangeal (PIP) blocking flexion and involved fingers.
  2. Active composite and individual wrist and finger flexion/extension.
  3. Repeat exercises from weeks 2-4 (steps 1-2).

Week 6

Orthosis: Remove orthosis except for sports and when protection is needed. Initiate buddy straps to involved fingers.

Exercises: (Out of the orthosis).

  1. Repeat exercises from Week 5 (Steps 1-2).
  2. Passive composite wrist and finger flex/extension stretching.
  3. Progressive light strengthening with yellow putty and tubing for grip, pinch, and wrist initiated.

Week 8

Orthosis: Discharge orthosis and buddy straps.

Exercises:

  1. Full active, passive, and blocking exercises for fingers and wrist for full ROM).
  2. Continue progressive strengthening with putty and tubing for grip, pinch, and wrist as needed.

Week 12-16

Full Return to activity without restrictions per MD.

Conclusion

This protocol outlines the gradual progression of orthosis management and exercises over several weeks to rehabilitate and regain full function after a flexor tendon injury. It’s important to follow the guidance of the medical professional overseeing the treatment.